UWISE OBGYN Flashcards
What is the definitive tx for pelvic pain due to endometriosis?
-hysterectomy with bilateral salpingo-oophorectomy
What is a radical hysterctomy used to tx?
-cervical cancer
What is endometrial ablation a tx for?
-menorrhagia
What type of IUD can be used for tx of endometriosis?
-levonorgestrel IUD
When are hysterosonograms contraindicated?
-when an infection is present!
What are 7 things that are associated with ACE-inhibitor use during pregnancy?
- Oligohydramnios
- Fetal growth retardation
- Neonatal renal failure
- HypoTN
- Pulmonary hypoplasia
- Joint contractures
- Death
What is the most common abnormal karyotype encountered in spontaneous abortuses?
-Autosomal trisomies
What are late decelerations associated with?
-uretoplacental insufficiency
What is the most significant risk factor for developing postpartum depression?
-personal history of depression
What is a leukoplakia? What should be done when one is found?
- leukoplakia = white plaque on the cervix
- should be biopsied ASAP, regardless of Pap smear outcome
How long does it take for the full response of leiomyomatas to GnRH agonists?
-three months
What 5 things does smoking increase the risk of in pregnancy?
- Placental abruption
- Placenta previa
- Fetal growth restriction
- Pre-eclampsia
- Infection
What amnt of proteinuria for mild pre-eclampsia? Severe ?
- mild = >300mg
- severe = >5000mg
Next step for a complex ovarian mass in a postmenopausal woman?
- surgical exploration
- could be an old enometrioma that was never resolved, but ovarian cancer should be r/o
- a complex cyst is not a physiologic cyst
What are the best imaging studies for anything involving the uterus and adnexa?
- ultrasound!
- so MRI and CT scans are usually not useful!
When can a dating US be done if there is discrepancy in dating?
- btwn 14-20 wks
- first trimester US are the most accurate in estimating dates
What test should be done first when fetal demise of one twin is noticed?
- maternal fibrinogen level
- when a dead fetus has been in utero for 3-4 wks the maternal fibrinogen level may decrease, which can lead to a coagulopathy
What is the spalding sign?
- overlapping of fetal skull bones
- suggests fetal demise
What kind of growth restriction can be caused by uteroplacental insufficiency?
- asymmetric GR
- normal length, weight is below normal, head is normal sized, small abdomen
What size fetal head will most likely need delivery via c-section?
- > 12 cm
3 Risk factors for PMS?
- Family Hx of PMS
- Vit B deficiency
- Calcium deficiency
- Magnesium deficiency
How much blood loss is considered postpartum hemorrhage in a vaginal delivery? C-section?
- vaginal delivery = >500 cc
- C-section = >1000 cc
When can pap smears be discontinued in elderly women?
-ages 65-70 yrs as long as they have had 3 consecutive negative pap smear or 2 negative within 10 yrs and no Hx of high grade cervical changes
4 Labor warnings?
- Contractions every 5 min for 1 hr
- rupture of membranes
- Fetal mvmnt less than 10 per 2 hrs
- Vaginal bleeding
Red-tender wedge-shaped area on the outer quadrant of the breast of a breast feeding woman?
-think: mastitis!
What 2 tocolytics are contraindicated in diabetics?
- Terbutaline
2. Ritodrine
What tocolytic is contraindicated in myasthenia gravis?
-magnesium sulfate
What are 4 common causes of acute pulmonary edema during pregnancy?
- Use of tocolytics
- Cardiac disease
- Fluid overload
- Preeclampsia
Why are pregnant women more suceptible to pulmonary edema?
-bc plasma osmolality is decreased during pregnancy
When is RhoGAM typically given?
- at 28 wks gestation for any Rh-negative woman
- again within 72 hrs of delivery to an Rh-negative woman if the baby was Rh-positive
- for any pregnancy, even if it doesnt end in a viable fetus in an Rh-negative woman
Where is the most common site of spread for an endometrial cancer?
-lungs!
What is the most accurate for detecting Down Syndrome?
-Quadruple screen
How will a septic infant appear at birth when chorioamnionitis is present?
- pale
- lethargic
- high temp
What happens respiratory wise in pregnancy?
- pregnancy causes respiratory alkalosis
- increased: inspiratoy capacity and reserve vol, + tidal volume, which causes an increase in minute ventilation
- decreased: functional residual capacity, residual volume
- overall causes physiologic shortness of breath
SV in pregnancy?
- increases!
- both HR and SV increase!
Physiologic hydronephrosis in pregnancy?
- due to compression of the ureter by the uterus and the right ovarian
- dilation tends to be more on the right bc of the dextrorotation of the uterus
What is the most common site for metastasis of molar pregnancies?
-lungs!
Max recommended weight gain during pregnancy in patients who are: underweight? Normal? Overweight? Obese?
- underweight : 28-40
- normal: 25-35
- overweight: 15-25
- obese: 11-20
What is the best screening blood test to do for an AA couple (with no significant hx) for preconception counseling?
-Hb electrophoresis
What screening test offers the highest detection rate for aneuploidys?
-sequential screen = first trimester NT and PAPP-A + second trimester quad screen
Whats is the risk of fetal loss with CVS?
-1%
Recommended daily folic acid dose for normal pregnancy? High Risk?
- normal = 0.4 mg/day
- high risk = 4 mg/day
Most common cause of variable deceleration?
-cord compression
Cause of late decelerations?
-uteroplacental insufficiency
What fetal complication can occur with the use of magnesium-sulfate in a preeclamptic patient?
-respiratory distress –> monitor the infant and give supplemental oxygen if necessary
How will an infant of chorioamnionitis look at birth?
-pale, lethargic, and have high temp
When should HIV testing be done on an infant born to a positive mom?
-begin at 24 hrs
What is the most common cause of postpartum hemorrhage?
-uterine atony
What is the most common bacterial cause of endometritis?
-mix of aerobes and anaerobes from the genital tract
Postpartum blues v depression?
- blues = lasts less than 2 weeks, self limited
- depression = lasts longer than 2 weeks
Btwn ages 30-65 what are the recommendations for cervical cancer screening?
-pap smear with HPV testing every 5 years
What is classically the cause of intense nipple pain with breast feeding?
-candida
4 Signs that a baby is getting sufficient breast milk?
- 3-4 stools in 24 hrs
- 6 wet diapers in 24 hrs
- Weight gain
- Sounds of swallowing
Conditions that need to be met before methotrexate can be used for tx of an ectopic pregnancy?
- Pt must be hemodynamically stable
- Nonruptured ectopic pregnancy
- size of ectopic pregnancy < 4cm w/out fetal HR or <3.5 w/ fetal HR
- Normal liver enzymes
- Normal renal fctn
- Normal WBCs
- Patient is reliable for follow up
What is the most common abnormal karyotype found in spontaneous abortuses in the first trimester?
-autosomal trisomies
When should a cerclage be placed?
-after the first trimester when necessary
When should patients at high risk be screened for GDM?
-ASAP with a 50-g oral gluocose challenge test
What non-invasive test can be used to detect severe fetal anemia?
-middle cerebral artery peak systolic velocity
Definition of fetal hydrops?
-collection of fluid in 2 or more body cavities of the fetus
What test should be done to determine the correct RhoGAM dose to give when there is more than the routine 30cc of fetal blood mixing with maternal blood?
- Kleihauer-Betke test
- causes maternal cells to be pale and fetal cells to remain stained, allows for counting of fetal blood cells
What is the standard dose of RhoGAM? How many cc of fetal blood does it account for?
- 300mg
- accounts for 30cc of fetal blood
What is the best way to gauge the severity of Rh hemolytic disease?
-measurement of bilirubin in the amniotic fluid
What type of twins most commonly has twin-twin transfusion?
-monochorionic diamniotic
When is the risk of microcephaly and severe mental retardation the greatest during gestation?
-weeks 8-15
What is considered a prolonged latent phase in a nulliparas woman? Multiparas?
- nulliparas = >20 hrs
- multiparas = >14 hrs
What 3 additional things does fresh frozen plasma contain?
- Fibrinogen
- Factor V
- Factor VIII
What is the most common cause of preterm labor?
-idiopathic
Which 2 tocolytics are CI in DM?
- Terbutaline
2. Ritodrine
Which tocolytics is CI in myasthenia gravis?
-Magnesium sulfate
MOA of Magnesium sulfate as a tocolytic?
-competes with calcium entry into the cells
When should indomethicin not be used as a tocolytic? Why?
- Should not be used after 32 wks
- can cause premature closure of the ductus arteriosis
What 4 effects do fetal steroids have?
- Increase pulmonary maturity
- Decrease incidence and severity of RDS
- Decreases intracerebral hemorrhage
- Decreases necrotizing enterocolitis in newborns
What medication has been shown to be the best in delaying the onset of labor in PPROM?
-antibiotics
The presence of what in the amniotic fluid suggests an intra-amniotic infection?
-amniotic glucose level of <20 mg/dl
What medication has been shown to reduce the risk of premature labor?
-17 alpha-hydroxyprogesterone
What type of decelerations are associated with uteroplacental insufficiency?
-late
What type of decelerations are associated with head compressions?
-early
What type of decelerations are associated with cord compression?
-variable
What should be done next for uterine atony that does not respond to medical tx?
-B-Lynch suture
When does milk “let-down” usually occur?
-2-3 days post partum
What effects can fluoxetine have on a fetus?
-pulmonary hypertension
Postterm pregnancy?
-completed 42 weeks
What are postterm pregnancies most commonly associated with?
-placental sulfatase deficiency
What can amnioinfusions be a tx for?
- tx of repetitive decelerations
- regardless of amniotic fluid meconium status
What does a 4th degree laceration involve?
-extends into the rectal sphincter and mucosa
Criteria for macrosomia in a diabetic mother? Non-diabetic?
- diabetic = >4000 grams
- nondiabetic = >4500 g
What cancer does a tubal ligation reduce the risk of?
- ovarian
- mechanism unknown
What is the strongest predictor of regret for a tubal ligation?
-age!
Antiphospholipid antibody syndrome tx?
-aspirin + heparin
Up to how many weeks can a vacuum assisted abortion be done?
-until 8 weeks
Tx of BV?
Metronidazole
Medical tx of detrusor instability?
- anticholinergics
- ex oxybutynin
Tx for endometriosis?
-OCPs + NSAIDs
Kallmann syndrome: What is it? Tx?
- arcuate nucleus doesnt secrete GnRH
- olfactory tract hypoplasia
- tx: pulsatile GnRH tx
Puberty wise, what is seen in McCune Albright Syndrome?
-premature menses before breast and pubic hair dev
Normal age of menarche?
-ages 9-17 yrs
What hormone is abnormal in PCOS?
-elevated testosterone!
Normal testosterone with a PCOS picture?
- think late onset CAH
- get 17-hydroxyprogesterone level!
Tx for hirsutism?
-spironolactone
What is the classic histologic description of lessions of endometriosis?
-endometrial glands/stroma and hemosiderin-laden macrophages
Histology of uterine fibroids?
-well-circumscribed, non-encapsulated myometrium
How many mg of Ca do postmenopausal women require per day?
-1200 mg
Most common reason why women stop taking postmenopausal hormone tx?
-vaginal bleeding
Hormone tx affects on lipids?
- increase HDL levels
- decrease LDL levels
What is considered osteopenia?
-1 to -2.5
What is seen on labs for exercise induced hypothalamic amenorrhea?
- normal FSH
- low estrogen
A deficiency in which vitamins has been shown to be related to an increase in PMS?
-vitamin A, E, & B6
Tx of mild PMS?
-OCPs
4 Risk factors for PMS?
- Family Hx
- Vit B6 def
- mag defi
Calcium def
What race has a higher risk for molar pregnancy?
-Asian
Tx of molar pregnancies?
-suction curettage
Partial mole?
- contains fetus/fetal parts &/or placenta/placental cord
- triploid karyotype (ex 69XXY)
- from 2 sperm fertalizing 1 egg
- show villi swelling
- have longer “gestations”, lower beta-hCG levels, and tend to get diagnosed as missed or incomplete abortions
Complete mole?
- does not contain any fetal or placental parts
- diploid (ex 46XX)
- from fertilization of an “empty egg” by 1 sperm or by 2 sperm
- show trophoblastic proliferation
- usually present with larger uteri, preeclampsia
- have higher likelyhood of developing into post-molar gestational trophoblastic neoplasia
How long should a patient wait after a molar pregnancy to conceve again?
-wait for 6 mnths of negative beta-hCG levels
Bx of suspicious choriocarcinoma lesions?
-NEVER!!! they are very vascular!`
What is the most common vulvular cancer?
-squamous cell carcinoma
Painless Mass in Bartholin’s gland?
- suspicious for malignancy!
- bx it!
abnormal pap in a 21-24 yr old?
- do HPV testing
- if positive, repeate pap in 1 yr
- if negative, continue with paps every 3 yrs
Tx for fibroids in a pt who wishes to remain fertile and hasn’t responded to NSAIDs?
-GnRH –> will shrink size only while on tx!
